Trencheva K.,Section of Colorectal Surgery |
Morrissey K.P.,Section of Colorectal Surgery |
Wells M.,Cornell University |
Mancuso C.A.,New York Medical College |
And 6 more authors.
Annals of Surgery | Year: 2013
OBJECTIVE: The purpose of this study was to identify patient, clinical, and surgical factors that may predispose patients to anastomotic leak (AL) after large bowel surgery. BACKGROUND: Anastomotic leak is still one of the most devastating complications following colorectal surgery. Knowledge about factors predisposing patients to AL is vital to its early detection, decision making for surgical time, managing preoperative risk factors, and postoperative complications. METHODS: This was a prospective observational, quality improvement study in a cohort of 616 patients undergoing colorectal resection in a single institution with the main outcome being AL within 30 days postoperatively. Some of the predictor variables were age, sex, Charlson Comorbidity Index (CCI), radiation and chemotherapy, immunomodulator medications, albumin, preoperative diagnoses, surgical procedure(s), surgical technique (laparoscopic vs open), anastomotic technique (staple vs handsewn), number of major arteries ligated at surgery, surgeonÊs experience, presence of infectious condition at surgery, intraoperative adverse events, and functional status using 36-Item Short Form General Health Survey. RESULTS: Of the 616 patients, 53.4% were female. The median age of the patients was 63 years and the mean body mass index was 25.9 kg/m. Of them, 80.3% patients had laparoscopic surgery and 19.5% had open surgery. AL occurred in 5.7% (35) patients. In multivariate analysis, significant independent predictors for leak were anastomoses less than 10 cm from the anal verge, CCI of 3 or more, high inferior mesenteric artery ligation (above left colic artery), intraoperative complications, and being of the male sex. CONCLUSIONS: Multiple risk factors exist that predispose patients to ALs. These risk factors should be considered before and during the surgical care of colorectal patients. Copyright © 2012 by Lippincott Williams & Wilkins.
Lamb S.V.,U.S. National Institutes of Health |
Massengill J.,U.S. Air force |
Sheridan M.J.,Inova Fairfax Medical Campus |
Stern L.E.,Section of Colorectal Surgery |
Von Pechmann W.,Inova Fairfax Medical Campus
Female Pelvic Medicine and Reconstructive Surgery | Year: 2015
Objectives: This study aimed to determine if abdominal sacral colpopexy (ASC) using mesh can be safely combined with sigmoid resection and anastomosis. Methods: This is a single institution, retrospective chart review of patients who underwent combined ASC and suture rectopexy with sigmoid resection between January 1, 2007, and December 31, 2011. Charts were screened for outcome data and complications related to the placement of synthetic mesh at the time of bowel resection to include readmission and reoperation rates, infection, bowel obstruction, fistula, and mesh erosion. Outcome data for patients receiving combined procedures were compared to 2 separate cohorts of patients as follows: a group that underwent only ASC with polypropylene mesh and a group that underwent only sigmoid resection plus or minus suture rectopexy. The DINDO surgical classification system was used for each cohort to further analyze complications. Results: There were 133 patients in the ASC only group (ASC only), 34 in the combined ASC and sigmoid resection group (Combined), and 27 in the sigmoidectomy plus rectopexy group (Colorectal only). The Colorectal only cohort had a higher rate of postoperative ileus; ASC only 3.8%, Combined 5.9%, Colorectal 22.2% (P = 0.004). There were otherwise no differences in intraoperative and postoperative complications or in the DINDO classification scores. Conclusions: Abdominal sacral colpopexy with placement of synthetic mesh at the time of sigmoid resection and anastomosis does not seem to increase the rate of intraoperative or postoperative complications. Copyright © 2014 by Lippincott Williams & Wilkins.